Definition: Artificial sweeteners are sugar substitutes that are often sweeter and have either no calories or fewer calories than sugar. Because these chemicals or natural compounds are much sweeter than sugar, smaller quantities can be used to achieve the same level of sweetness in foods and beverages.

There are two types of sweeteners: nutritive and non-nutritive. Artificial sweeteners have few, if any, calories, and therefore are non-nutritive because they do not provide energy. Nutritive sweeteners have calories and provide energy. Examples include table sugar (sucrose), honey, fruit sugar (fructose), sugar alcohols, and high-fructose corn syrup.

Artificial sweeteners are classed as food additives and must be approved by the U.S. Food and Drug Administration (FDA).

Saccharin (Sweet'N Low®, SugarTwin®) is the oldest artificial sweetener, and is 300-500 times sweeter than sugar. Saccharin was accidentally discovered in 1879 at Johns Hopkins University by Ira Remsen and Constantine Fahlberg, who were researching coal-tar derivatives. Fahlberg later patented saccharin. Saccharin became popular during World War I, when sugar was scarce in the United States. During the 1960s and 1970s, it became commonplace for dieters' use. In the 1970s, it was reported to be linked to cancer, and the FDA made it mandatory to place warning labels on it.

Aspartame (NutraSweet®, Equal®) was accidentally discovered in 1965 by Jim Schlatter, a chemist at GD Searle. Aspartame is 200 times sweeter than sugar. Aspartame was not approved by the FDA until 1981 due to numerous conflicting studies linking it to cancer.

Acesulfame K (ACK, Sunett®, Sweet One®) was accidentally discovered in 1967 by Karl Clauss, a German chemist at Nutrinova, a global manufacturer of food constituents in Frankfurt, Germany. Acesulfame K was FDA-approved in 1993. It is 180-200 times sweeter than sugar.

Sucralose (Splenda®) was discovered in 1976 by Shashikant Phadnis, a graduate student at King's College, London. Sucralose is 600 times sweeter than sugar and was approved by the FDA in 1998. This is the only non-nutritive sweetener that is made by converting sugar into a no-calorie artificial sweetener.

Safety: Many people prefer to use artificial sweeteners instead of sugar because they do not have the same negative effects as sugar. For instance, unlike sugar, artificial sweeteners do not appear to increase the risk of tooth decay, diabetes, and weight gain.

However, there is conflicting evidence about the safety of artificial sweeteners. Although artificial sweeteners have been shown to satisfy the consumer's "sweet tooth," there are some potential health risks to consider.

New product: Neotame is an example of a newer artificial sweetener. This artificial sweetener, similar in structure to aspartame, was created by NutraSweet Property Holdings, Inc. It was approved as a sweetener and flavor enhancer by the FDA in 2002 and is 7,000-13,000 times sweeter than sugar. Studies report that Neotame does not appear to increase the risks of tooth decay, weight gain, or diabetes.

Natural sweetener: Stevia rebaudiana (TruviaT, PureViaT) is a plant in the chrysanthemum family that is native to South and Central America. This natural sweetener is calorie-free and appears to have fewer safety concerns than artificial sweeteners. It has 300 times the sweetness of sugar and does not appear to increase the risk of tooth decay. Rebaudioside A (Reb-A), the active ingredient extracted from stevia, was approved by the FDA in 2008.

Additionally, some early evidence suggests that stevia may be beneficial for high blood pressure or high blood sugar levels.

General: Artificial sweeteners may be used in food or beverage products instead of sugar to help reduce the risk of tooth decay, to lower the calorie content of foods or beverages, and to help consumers with diabetes to control their blood sugar levels more effectively.

Studies have shown that sugar may contribute to tooth decay, diabetes, and weight gain. These same problems have not been attributed to artificial sweeteners.

Metabolism: Artificial sweeteners do not affect the body the same way as sugar because they have different chemical structures.

Tooth decay: Tooth decay is defined as the demineralization (loss of minerals) in a tooth, resulting in the formation of a hole or cavity. Acids produced by bacteria (usually Streptococci and Lactobacilli) live in dental plaque and may cause demineralization. The bacteria eat sugar and produce waste products in the form of acids, which are responsible for tooth decay. Artificial sweeteners do not promote tooth decay because they do not contain sugar, and without sugar, bacteria cannot produce acids.

Weight gain: Carbohydrates are mainly responsible for providing the body with energy. Sugar (glucose) is a type of carbohydrate. Cake, flavored gelatin, ice cream, bread, pasta and rice contain carbohydrates. Carbohydrates have four calories per gram. Sugary foods and beverages have more carbohydrates in them than non-sugary items. The calories from sugary foods are sometimes referred to as "empty calories." This means that they do not provide much nutritional value, and consuming a small amount may add many carbohydrate calories to a person's diet. Large amounts of calories without adequate exercise may lead to weight gain and obesity.

Research suggests that the more sugary foods and beverages people consume, the more they want to consume. This craving for sugar makes dieting difficult for some people, as they may not be able to resist urges to consume high-calorie sugary foods and beverages. Therefore, some dieters may choose to consume foods or beverages that contain artificial sweeteners.

Diabetes: For both adults and children, the American Diabetes Association (ADA) recommends that about 50-60%of total calorie intake per day should be in the form of carbohydrates.

People with diabetes need to be aware of how to choose carbohydrates. Although all carbohydrates carry four calories per gram, some carbohydrates raise the glycemic index (GI) or glycemic load (GL) more than others. .

Insulin, a hormone produced by the pancreas, is responsible for keeping the level of sugar in the bloodstream within a normal range and facilitating the movement of glucose (sugar) into the body's cells in order to give the body energy. The GI/GL is a measure of how a specific food affects blood sugar levels, with each food being assigned a numbered rating from 0 to100. The lower the rating, the slower the absorption and digestion process, which produces a gradual rise in blood sugar and insulin levels. The higher the GI/GL rating, the faster blood sugar levels can increase. This triggers insulin levels to rise quickly and may aggravate diabetes symptoms.

Diabetes is a condition in which the body either does not produce enough insulin or does not properly respond to insulin. As a result, blood glucose levels are too high. This may lead to serious complications, including blindness, nerve damage, and kidney damage.

Sugary foods and beverages such as cake, ice cream, and soda, have a higher GI/GL than other foods with less sugar. Because artificial sweeteners do not affect the GI/GL, people with diabetes may choose to consume artificially sweetened foods because they will not aggravate their diabetes.

Many companies use artificial sweeteners in the foods and beverages that they manufacture, such as gum, dairy products, baked goods, soft-drinks, and frozen desserts. They can also be used by consumers as powders, granules, or liquids to sweeten foods and beverages, including tea, coffee and yogurt. Some artificial sweeteners can be used in cooking and baking.

Artificial sweeteners may be added to some vitamins/drugs (such as cough syrup, antacids, and vitamin C) to make them more palatable. They may also be used in toothpaste, mouthwash, and breath mints. Additionally, they may help improve texture and add bulk. Further, they may slow food spoilage because they do not support the growth of mold or bacteria the same way sugar does.

Chemists have isolated the "sweet receptor," or the receptor on the tongue that signals the brain that a food or beverage is sweet. Researchers have identified thousands of sweet-tasting compounds that trigger these taste-bud receptors.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.